1Anoosha Aslam, 1Michael Neale

1Royal North Shore Hospital, Sydney, Australia

Introduction:

Isolated spontaneous renal artery dissection (ISRAD) is a rare clinical entity with significant clinical effects on patients. The likely causes of isolated renal artery dissection include spontaneous, traumatic or iatrogenic factors. The goal of this report is to study a case of ISRAD which was managed non-operatively and eventually resulted in spontaneous recanalisation of the renal artery.

Case Report:

A 57 year old lady presented to the Emergency Department with a 5 day history of right flank pain. This is on a background of aortic ectasia which was being monitored yearly with no previous requirement for intervention. She was afebrile, blood pressure was 152/88, and heart rate 84. Creatinine was 88 and eGFR 63. Urinalysis was negative for leukocytes/nitrites. Computerised tomography (CT – arterial phase) demonstrated occlusion of the right renal artery and infarction of the right kidney. The patient was commenced on anticoagulation (unfractionated heparin infusion) and monitored. She was given oxycodone for analgesia. During admission she developed a systemic inflammatory response with fever and rising inflammatory markers and was noted to have a left pleural effusion on imaging. This was treated with intravenous antibiotics with good effect.

On discharge her renal function normalised (Cr 68, eGFR 86), and inflammatory markers were down trending. She was discharged on apixaban and followed up in two months time. Repeat CT demonstrated recanalisation of the right renal artery.

Discussion:

The most likely of the patient’s renal artery occlusion was dissection with superimposed thrombosis. There was no change in the known ectasia of her abdominal aorta on imaging. She was managed conservatively as her renal function returned to normal and she responded well to anticoagulation.

Conclusion:

The decision to treat isolated SRAO is a complex one. In this case the patient did not require intervention and eventually developed spontaneous recanalisation of the renal artery with normal resistive index. However further case reports and data will be required to assess whether there is an overall benefit in intervention for spontaneous renal artery occlusion and dissection.